What to do for an acute ankle injury this season?
This year's winter sports season is about to take shape. Due to COVID-19, preparation has been challenging, with many having minimal pre-season training. It's important to recognise this and ensure you are ready. If you have suffered previous ankle injuries, or would like to reduce your risk of injury and improve performance, talk to your Physiotherapist today. Please contact us if you would like more information or look out for our videos on our social media platforms.
Function of the ankle ligaments :
The ligaments surrounding the ankle joints provide passive stability and limit range of movement to our ankle joint. Ligaments run from bone to bone to stabilise the joint and are controlled automatically through feedback from our brain .
There are three main groups of ligaments around the ankle .
The lateral ligaments (on the outside of the ankle) . These ligaments are commonly injured with inversion (rolling the ankle in ) .
The medial deltoid ligament – ( on the inside of the ankle) . This ligament is a lot harder to injure as it is a broad fan shape with a deep and superficial layer. It typically takes longer to heal and return to sport.
The syndesmosis ligaments- or high ankle sprain : these ligaments bind the distal tibia and fibula .
Common mechanism of injury
In most cases, the mechanism of injury for spraining the lateral ligaments is a plantar flexion (toes pointed) with inversion (foot rolling inwards) combination. When the force applied to the ligaments is greater than their ability to absorb and withstand that force, overstretching and tearing of a percentage of the fibres occurs. You may notice your Physiotherapist will grade an injury between 1-3 depending on the severity of the injury and tearing present, varying from a small tear or overstretching of fibres, to complete rupture of the ligament .
Even a complete rupture of the lateral ligaments can often respond well to rehabilitation without the need for surgery. Often, people present to our clinic reporting that they have rolled their ankle whilst changing direction during sport , landing and rolling their ankle on impact or landing on an opponent's foot. We typically see an increased incidence of ankle injuries in sports with cutting or change of direction manoeuvres, which we see in all football codes as well as court sports like netball and basketball .
Predisposing factors :
There are a number of predisposing factors which may lead you to an increased chance of suffering an ankle injury. As a physiotherapist, we try to address these issues whilst also treating the local ankle injury when you present for your rehabilitation .
These include:
Previous ankle / knee injuries
Poor hip and knee control particularly on jumping and landing
Poor balance on a single leg test
Reduced calf strength/ ankle range of movement .
What is our role as Physiotherapists early in the rehabilitation phase .
I find it is a common misconception that there is not much that Physiotherapy can achieve immediately after the initial injury particularly while there is a large amount of swelling present . One of our main goals of Physiotherapy in this early phase apart from assessing the severity of the injury ( and giving advice on timeframes for return to sport / training loads etc) is to minimise the accumulation of swelling at the ankle and foot as well as start our early rehab . In some cases , an Xray may be indicated, which we can organise a referral.
In most cases in this early phase , even in the first few days post injury, there are exercises that we can start to maintain ankle mobility, strength and balance . We may use taping and/or bracing in this early stage to help with stability, pain relief and swelling management .
Overall our goal is to stimulate and allow maximal healing and to get you back doing your chosen sport/activity as quickly and safely as possible .
In the later stage of your rehabilitation, we guide you through your strength and stability program, return to running programs and return to training and sport.
We typically see that the sooner you start your ankle rehab, starting with the RICER principal as well as early assessment, you set yourself up with a more rewarding rehabilitation process.
Injury prevention is often an aspect of sport that is overlooked. To combat this our physiotherapist Curtis has designed a video series focusing on several exercises aimed to challenge your ankles, and highlight any areas that may be in need of further attention. This video can be found on our social media “Returning to sport series - The Ankle”.